If you are having any symptoms or have any questions, please call 811 to speak with a registered nurse 24 hours a day.

Get emergency care if you or a loved one has serious thoughts of suicide or harming others.

OVERVIEW

What is a heart attack?

A heart attack happens when part of the heart muscle is cut off from oxygen. If the oxygen isn’t restored soon, a heart attack occurs. The blood in your coronary arteries carries oxygen to the heart muscle. Most heart attacks occur when a blockage slows or stops blood flow. Heart attack is sometimes called myocardial infarction or acute coronary syndrome. Heart attacks are often treatable when diagnosed quickly. However, they can be fatal.

Women are less likely to survive heart attacks than men. No one knows why. It may be that women don’t seek or receive treatment as soon as men. Their symptoms can be different from what men experience. Their symptoms may be milder and more often overlooked. Or it may be because women’s smaller hearts and blood vessels are more easily damaged. Doctors are working on finding answers to these questions. It’s important to prevent heart problems before they start.

SYMPTOMS

The most common symptoms of heart attack may include:

• Chest discomfort (also called angina), which may feel like pain, pressure, tightness, heaviness or burning like heartburn.
• Pain or discomfort in the neck, shoulders, lower jaw, arms, upper back or abdomen.
• Shortness of breath that lasts more than a few seconds.

Other symptoms could include:

• Feeling lightheaded, dizzy or faint.
• Nausea and/or vomiting.
• Unusual sweating.
• Overwhelming fatigue.
• Feeling anxious.
• Heart palpitations (feeling like your heart is beating really fast, or out of rhythm).
• Feeling unusually tired for no reason (sometimes for multiple days)

Are the symptoms of heart attack different for women?

The most common symptom for women is pain or discomfort in the chest. However, women are more likely to have a heart attack without having any chest pain. Women should be especially aware of the other possible symptoms of heart attack. This includes shortness of breath, sweating, fatigue and dizziness.

What should I do if I have symptoms of heart attack?

If you think you may be having a heart attack, it’s important to seek treatment right away. Follow these steps:

• Dial 911 right away. Do not drive yourself to the hospital.

Follow their instructions.

• If you are alone and are able, unlock your door to let emergency help enter your home.
• Sit in a comfortable chair and wait for help.
• Keep a phone near you.

CAUSES & RISK FACTORS

What causes heart attack?

A heart attack occurs when part of the heart muscle is damaged or dies from lack of oxygen.  When a blockage occurs in your coronary arteries, blood and oxygen don’t get to the heart. This can lead to a heart attack if it isn’t treated quickly.

Most heart attacks are a result of coronary heart or artery disease. A waxy substance called plaque builds up in the arteries. This is called atherosclerosis. It takes years for the plaque to build up. When the plaque breaks up, it travels through the blood stream. This creates blood clots. The clots slow or stop blood flow to the heart. Then the heart doesn’t get enough oxygen. The tissue not receiving the oxygen begins to die.

Risk factors for a heart attack:

• Smoking
• Diabetes
• Age—the older you are, the higher your risk
• High cholesterol level
• High blood pressure
• High blood sugar
• Family history of heart attack
• Race—people of African, South Asian, and Indigenous descent are at increased risk
• Lack of exercise
• Stress
• Obesity
• Gender — More men have heart attacks, although heart disease and stroke is the leading cause of death for Canadian women.

A less common cause of heart attack is a severe spasm, or tightening, of a coronary artery. This can happen in an artery that doesn’t have plaque build-up. Instead, the tightening cuts off the blood flow. Spasms aren’t as well understood as a cause for heart attack. They seem to be related to:

• Taking specific drugs, such as cocaine
• Cigarette smoking
• Exposure to extreme cold
• Severe emotional pain or stress

DIAGNOSIS & TESTS

How is heart attack diagnosed?

You may need several tests to determine the cause of your symptoms.

• Electrocardiogram (ECG, or sometimes called “EKG”): This test records the electrical activity of your heart. It can help diagnose heart rhythm problems. It can also find damage from a decrease in blood flow.
• Blood tests: When blood flow decreases, special proteins leak into the blood system. A blood test can detect these proteins. Your doctor may want to test your blood several times during the first 24 to 48 hours after your symptoms start.

Other tests your healthcare provider may want you to have include:

• Echocardiogram: This test sends out sound waves to create pictures of your heart. It can show if there are problems with your heart valves.
• Chest X-ray: This looks at the size and shape of your heart. It can show if there is any fluid in your lungs.
• Nuclear imaging: This test injects a tiny amount of radioactive substance into your blood. This substance travels to your heart to create pictures of it. It shows how well your heart is pumping. The radioactive substance is safe and leaves your body after the test is finished.
• Coronary angiography: This test is sometimes called cardiac catheterization. In this test, a long tube is inserted into a blood vessel. The tube is guided to the heart or arteries that carry blood to the heart. Then, a substance is injected into the tube. This substance is visible by X-ray. It allows your healthcare provider to see where the blockage that caused the decrease in blood flow to your heart is located.

PREVENTION

Can heart attacks be prevented or avoided?

A healthy lifestyle can help prevent heart attack. This includes:

• Quitting smoking if you smoke and avoiding secondhand smoke.
• Following a healthy diet that is low in fat and cholesterol.
• Exercising regularly
• Managing stress
• Controlling your blood pressure
• Managing your blood sugar (if you have diabetes)
• Seeing your healthcare provider regularly for check-ups

Hormone replacement therapy, HRT can be used to treat the symptoms of menopause. If you’re taking HRT contact your healthcare provider about whether HRT is right for you.

TREATMENT

Your treatment will depend on what is causing your symptoms. If you have an acute case of angina (chest pain), your healthcare provider will probably give you nitroglycerin. Nitroglycerin can temporarily relieve your symptoms and improve blood flow to your heart. It does that by widening the arteries that carry blood to the heart.

If you are having a heart attack, your healthcare provider may:

• give you a medicine. This medicine is called a thrombolytic. It can help dissolve the blood clot that is blocking the coronary artery.
• do an angiography. (X-ray of the blood vessels).
• Do a percutaneous coronary intervention (PCI, formerly known as angioplasty or stent). This involves inserting a tiny balloon into an artery in your arm or leg. The balloon is threaded up the artery to the heart. The balloon pushes open blocked coronary arteries. A small metal rod called a stent might be put into the artery where the blockage was to hold the artery open.
• Do coronary artery bypass surgery. This is a major surgery, in which the healthcare provider takes either veins from your legs and/or an artery from your upper body to bypass the blockages in your coronary arteries. Coronary bypass surgery allows blood to flow to the area of the heart past the blockage.

Treatment of heart attack also includes medicines that you will need to take even after you leave the hospital. These medicines help improve blood flow to your heart, prevent clotting, and reduce the risks of having another heart attack.

These medicines include:

• Aspirin,
• beta blockers,
• statins,
• ACE inhibitors.

Your healthcare provider will prescribe the medicines that are right for you.

If you have had a heart attack, your healthcare provider will also talk to you about lifestyle changes you can make to prevent more heart problems.

What is a cardiac rehabilitation program?

Before you leave the hospital, your healthcare provider will probably talk to you about a cardiac rehabilitation program. These programs provide information that will help you understand your risk factors. The program will also guide you to begin a heart-healthy lifestyle that can prevent future heart problems. You will learn about exercise and diet, and how to reach and maintain a healthy weight. You will also learn ways to control your stress level, your blood pressure and your cholesterol levels.

Your cardiac rehabilitation program will probably start while you are still in the hospital. After you leave the hospital, your rehabilitation will continue in a rehab center. The rehab center may be at the hospital or in another location.

Most cardiac rehabilitation programs last 3 to 6 months. Your healthcare provider will talk to you about how often you need to attend the program. Once you enroll in a cardiac rehabilitation program, regular attendance is very important. The more lifestyle changes you make, the better your chances of preventing future heart problems.

The sooner you get medical help, the greater your chances of surviving a heart attack. Do not delay getting immediate medical attention if you are experiencing symptoms of heart attack.

 Living with a heart attack

After you’ve had a heart attack, you are at higher risk of having another one. Your healthcare provider will likely recommend heart-healthy lifestyle changes to help reduce your risk. They include:

• Maintaining a heart-healthy diet
• Working toward a healthy weight
• Managing your stress
• Being physically active
• Quitting smoking

Symptoms during a second heart attack may be different than the first one. If you have any new symptoms of heart attack or are in any doubt, call 911. Early treatment is the key to survival.

Will I have to take medicine for the rest of my life?

If you have had a heart attack, your doctor will probably want you to take certain medicines for a long time. This can help reduce your risk of more heart problems. Your doctor can answer your questions about these medicines. They can tell you the benefits and risks of taking them.

• Aspirin can reduce the risk of a heart attack. Your healthcare provider may want you take a low dose of aspirin each day to keep your blood from forming clots that can eventually block the arteries. However, a daily dose of aspirin may not be right for everyone. Contact your healthcare provider about the risks and benefits of aspirin therapy.
• Antiplatelet drugs can also help stop blood clots from forming. Blood clots can block the arteries that carry blood and oxygen to the heart (called the coronary arteries) and cause a heart attack or a stroke. These drugs are especially important to take for at least a year if you have had a stent placed in your heart.
• Beta blockers are a group of drugs that lower the heart rate and blood pressure. They help improve blood flow to the heart.
• ACE inhibitors are a group of drugs that can help if your heart is not pumping blood well. This medicine helps open (dilate) your arteries and lower your blood pressure. This improves blood flow.
• Statins are a group of drugs that are used to lower “bad” cholesterol (also called LDL, or low-density lipoprotein) levels and may help increase “good” cholesterol (also called HDL, or high-density lipoprotein).

What does depression have to do with my heart attack?

Depression is common after a heart attack. As many as 1 out of every 3 people who have a heart attack report feelings of depression. People with a higher risk of depression after a heart attack include:

• Women,
• People who have had depression before,
• People who feel alone and without social or emotional support

Many people who have depression don’t recognize it. They don’t seek help or get treatment. Being depressed can make it harder for you to recover physically. Depression can be treated.

Some people have anxiety after a heart attack, fearing it will happen again. Talk to your healthcare provider about your feelings so that you can manage or reduce your anxiety.

FOR MORE INFORMATION

Heart and Stroke Foundation of Canada

Toll free 1-888-473-4636

http://www.heartandstroke.ca/